Diabetes basic notions are the fundamentals of your new life
Author: Dr Sorin Ioacara | Last update: 3 September 2020
Diabetes in children is a set of many endocrine and metabolic imbalances, with the increase in blood sugar as the common denominator. The primary defect consists of the body’s inability to produce enough insulin. Also, there may be a significant increase in insulin requirement. This may appear as a result of a decrease in the efficiency of how the body uses insulin. In other words, there is insulin resistance.
Diabetes affects all three metabolisms: carbohydrate, protein and lipid. The most dangerous changes are in lipid metabolism. Indeed, the lack of sufficient insulin leads to the unlocking of free fatty acids (blood fat) conversion into ketone bodies.
The accumulation of ketone bodies in the blood leads to the appearance of diabetic ketoacidosis coma. This is a potentially fatal complication.
In this chapter, we will discuss the basic notions that everyone should understand at the beginning of their lives with diabetes. It is indeed, a new life. However, it can be beautiful, happy and rewarding!
Diabetes diagnosis in children
The diagnosis of diabetes has a dedicated chapter. In short, doctors make the diagnosis of diabetes in children based on a combination of specific symptoms and high blood glucose values. Usually, the child is visiting the doctor because of altered general condition. After discussing with the paediatrician, the parents typically admit that their child had symptoms for the last two weeks.
The diabetes classification has a dedicated chapter. A thorough knowledge of the various types of diabetes mellitus offers the chance of recognizing some rare forms of diabetes. The most common form of diabetes in children is type 1 diabetes. As obesity in children becomes more and more widespread, cases of type 2 diabetes also begin to appear. In some regions of the world, type 2 diabetes might represent up to 50% of all the cases locally registered in children.
The onset of diabetes in the first six months of life makes the diagnosis of neonatal diabetes. This form of diabetes is fundamentally different from type 1 diabetes. Here, the problem is a genetic mutation isolated to a single gene (monogenic diabetes).
Glycosylated hemoglobin (HbA1c) has a dedicated chapter. HbA1c provides an estimated average of blood glucose levels over the last three months. For the vast majority of children and adults outside pregnancy, HbA1c target is below 7% (53 mmol/mol). Patients with HbA1c values within their goal may repeat the analysis every six months. On the other hand, those who have an HbA1c outside their target should intensify all diabetic therapeutic measures and recheck their HbA1c after three months.
Ketone bodies are acids made by the liver from the fat available from the blood. A relatively small amount of blood insulin is sufficient to block the production of ketone bodies. Consequently, as the blood insulin concentration gets below a certain threshold, the ketone bodies production from the liver ensue. Finally, their accumulation in the blood causes a severe complication of diabetes called diabetic ketoacidosis.
A decrease in blood glucose below 70 mg/dl (3.9 mmol/l) defines hypoglycemia. This is true whether or not the patient has symptoms. Blood glucose levels between 69 and 54 mg/dl (3.8-3 mmol/l) define level 1 hypoglycaemia if, of course, the patient was able to solve the situation by himself. In general, hypoglycaemia becomes dangerous for the body when blood glucose drops below 54 mg/dl (3.8 mmol/l). Therefore, up to this figure, the glucose values are instead considered “alert values”.